The well-known Groper pediatric partial bridge is a space maintainer for children who have lost anterior teeth prematurely. It was first introduced in the 1980s and gained popularity among dentists due to its many benefits and durability.(1) However, recently the Groper has become a source of confusion for dentists, as some dental labs are now offering a different version of the appliance, and some dentists are fabricating them on their own. As a result, dentists and dental assistants are often surprised to find that from one lab to another, the Groper can look different, be constructed of different materials, and have different lifespans.

At the annual meeting and expo for the American Association of Pediatric Dentistry (AAPD), dozens of dentists visiting our booth (Ohlendorf Appliance Laboratory) asked why some Groper appliances don’t last as long as others. They also wanted to see what my company’s version looks like. What we learned is that many dentists are ordering a different version of the Groper that doesn’t feature its most important element—the Groper pads.

This article will address the differences in today’s Groper appliances and discuss the benefits of the appliance.

The pseudo or imitation Groper appliance is more prone to breakage because it lacks reinforcing pads.

The benefits of a Groper appliance

The Groper appliance can hold open space for a single missing tooth or as many as four missing teeth (upper and lower) that have been lost due to accident, dental caries, or illness. The Groper functions both aesthetically, improving the child’s appearance, and as a preventive treatment by proactively preserving an open space to avert arch length loss and the resulting crowding. The Groper also restores function and allows maxillary growth. As a fixed rather than removable appliance, the Groper is less likely to break and doesn’t require the child’s cooperation.(2)

The Groper supports speech development in young children who have lost maxillary anterior teeth. Because the tongue uses the lingual sides of these teeth for certain phonic sounds such as “s,” “z,” and “th,” the absence of these teeth often results in improper speech.(3) While one study found that early loss of incisors had no long-term effects on speech, most dentists consider the Groper helpful in that it allows a child to communicate as he or she did before the tooth loss, which reduces frustration.(4)

Using a space maintainer such as the Groper also prevents improper tongue function. Leaving the space open, patients cannot create proper suction for swallowing and speech, so they compensate with tongue thrusting. This can lead to anterior open bites and a narrowing of the upper arch.

Another big advantage of the Groper is the social and emotional impact that a partial bridge can provide a child. Children, even those of preschool age, are aware of their appearance and can feel embarrassed or self-conscious about gaps that may last for several years until the adult teeth erupt. It’s important to choose a Groper appliance that features fully functional, realistic-looking teeth.

Acrylic resin is the preferable material over a composite because the teeth will not stain. In addition, the acrylic resin teeth are available in all shades on the Universal Shade Guide so they can be matched to a child’s natural teeth.

A broken imitation Groper.

What’s a true Groper and how is it different?

The original or true Groper is a durable, fixed appliance designed to last until a child’s adult teeth begin to erupt. This might mean as many as two or three years, depending on the age of the child when he or she was first fitted with this custom appliance. The strength and durability of the appliance is due to its construction—each prosthetic tooth is individually attached to a metal pad that is laser welded to the palatal wire.

Some of the pseudo versions that are being labeled Groper are much less durable than a true Groper because they do not feature the pads. Instead, the appliance is simply fabricated with a wire that is adhered to the back of the prosthetic teeth. This type of appliance breaks easily, sometimes after as few as two months of use.

The Groper can be made with bands or stainless steel crowns, depending on the doctor’s preference. It can be anchored on deciduous molars or first permanent molars if these are erupted enough to band.

Conclusion

Dentists should be aware of the differences between the true Groper Pedo Partial and imitations. The most easily discerned difference is that the true Groper features an individual pad for each tooth that is laser welded to the lingual wire for additional strength. While these pads may be small, they make a big difference in terms of strength, durability, and longevity.

ELECTRONICALLY REPRINTED FROM JULY 2013 DENTAL PRODUCTS REPORT

As a periodontist of 43 years I’m naturally leery. I started using this product in 2007 after I’d caught wind of it through various journals. I thought it might have some potential because it’s got a good scientific basis to it, so I decided to give it a try. Now, I think this tool is as powerful as the toothbrush, and I think in a generation, trays are going to change the face of dentistry.

In the five years you’ve used PerioProtect®, how has it worked out for you?
The Perio Tray® is a fabulous product. I mean it’s not a cure-all but it is probably the strongest tool I use in the maintenance portion of my practice. As I’ve used it, my use has evolved. When I first began to use it I limited it to those maintenance patients that I thought were failing, you know, excessive bleeding, poor home care, lack of compliance. As time has gone by I’ve changed to the point where it’s now an alternative to strict two or three-month recall and it frees up the patient a considerable amount in milder cases. I’m even beginning to use it now as a way to minimize the amount of periodontal surgery I do.

What was the process of incorporating the PerioProtect Method® into your practice like?
I thought it went smoothly enough. It took some education on my part because at the time my staff was not familiar with taking impressions or pouring stone. Once I determined that this was a product I was going to go with and continue to use, it was about a six-month process to get it incorporated. Up until then I had been doing all of these things myself, so I broke out of my normal periodontal routine and trained my staff, and after about a year things smoothed out.

Now my staff is very enthusiastic about it and my hygienists are comfortable spotting the patients they think it would help as well as explaining it to them. I keep the PerioProtect® website on my business card so we can refer patients to it and let them get an idea of what we’re talking about, and I think that’s been a useful tool.

What kind of changes have you observed since integrating this product?
It has minimized the amount of surgery I have to do, and quite frankly as a periodontist that has made my life quite a bit easier. It’s a whole lot easier to tell a patient I have three teeth I need to fix instead of when I was a young dentist and none of the medications were available. Back then I was doing full mouth surgery after full mouth surgery. It’s been a very powerful tool. I can’t say enough nice things about this product.

What would you say is its biggest benefit?
There many features that are hugely beneficial—maintenance, minimizing surgery, geriatrics—but the absolute biggest benefit without a doubt in my mind is it’s one of the few tools that helps with controlling bleeding. Over the last 20 years disease after disease has been found to be associated with periodontal disease and the bleeding and inflammation periodontal disease causes. I think there’s a tremendous health benefit associated with Perio Trays® .

Would you recommend this product to a colleague?
It works and it always works well. It’s a wonderful product. It’s not a stand-alone product but if you combine it with the other routine things that are used with periodontal disease, it’s a tremendous tool.